94 Opioid Use in the IBD Population – A Retrospective Analysis From a Single Tertiary Care Center

Background: Opiate use remains relatively common in inflammatory bowel disease (IBD) despite growing concerns about its safety and studies linking its use to increased healthcare utilization, morbidity, and mortality. For treating abdominal pain in IBD, major society guidelines recommend against chronic opioid use and instead, endorse optimizing IBD therapy, non-opioid pain management, and various non-pharmacologic approaches. This study aims to investigate the use of opiates in IBD patients in a single center, with a focus on demographics, healthcare utilization, and prescribing patterns. Methods: This was a retrospective, observational cohort study reviewing IBD patients seen at our tertiary care center between January 1, 2020 and November 1, 2024. The EPIC Report feature was used to identify our study population and obtain information about IBD subtype, opioid use, and outcome measures. The patients were separated into one of 2 cohorts depending on the presence of an opioid prescription during the study period. The groups were then compared on multiple measures. For statistical analysis, t-tests and chi square tests were performed on quantitative and categorical variables, respectively. Results: In total, 4,422 patients with IBD were seen at our center during the study period. Of these patients, 39% were prescribed an opioid. The patients were separated into one of 2 cohorts (Non-Opioid Group, Opioid Group) based off their use of opioids during the study period. When compared to the non-opioid group, the opioid group had a higher proportion of Crohn’s disease (54% vs 49%; P < 0.05), was predominantly female (63% vs 56%; P < 0.05), older (53-year-old vs 49 year-old, P < 0.05), had a higher average BMI (28.3 kg/m2 vs 27.4 kg/m2, P < 0.05), twice the rate of active smoking (7% vs 3%; P < 0.05), a higher percentage of Black patients (20% vs 12%; P < 0.05), and twice the percentage of patients with Medicaid (15% vs 7%; P < 0.05). The opioid group was greater than 8 times more likely to have visited the emergency room within the last year (0.42 visits/patient/year vs 0.05 visits/patient/year; P < 0.05) and 34 times more likely to have had a hospital admission within the past year (0.34 admissions/patient/year vs 0.01 admissions/patient/year; P < 0.05). There was no significant difference in the average fecal calprotectin between the groups (388 vs 417; P = 0.46) or the rate at which they were prescribed advanced therapies (44% vs 44%; P = 0.98). There was a higher average CRP in the opioid group (3.47 vs 2.55; P < 0.05). Use of steroids was higher in the opioid group (20% vs 13%; P < 0.05). Only 1% of the opioid prescriptions were written by IBD specialists. Of the patients prescribed opiates, 35% had opiates in their current medication list, suggesting chronic use. Conclusions: This study highlights disparities in opioid use among IBD patients and confirms the association between opiate use and higher healthcare utilization and steroid use. About one-third of patients prescribed opiates were chronic users, despite concerns about narcotic use for chronic pain in IBD. Opiates are rarely prescribed by IBD specialists but remain commonly prescribed for IBD patients.